IAPT Northwest Leadership & Innovation Forum

‘Moving IAPT Forward’

Wednesday 14th January, 2015

Psychological Therapies for Deaf People

BSL Healthy Minds

• First psychological therapy primary care service for

BSL users in England

• Step 2 & Step 3 interventions

• Culturally Deaf aware, fluent BSL therapists

• CCMS & CS provided by appropriately qualified &

BSL fluent practitioners

• Open referral system (depends on area)

BSL Healthy Minds

• Outcome measures (GAD7, PHQ9, W-SAS)

translated and validated into BSL

• BSL IAPT training course

• Northumberland Guided Self Help materials –

translated into BSL

• No BSL Interpreters

• Most therapy sessions in GP surgeries

• Delivered by a Deaf organisation

Current snapshot of BSL HM

North West Evaluation

• Excellent recovery rates

• Low drop outs

• High patient satisfaction (87%)

• Highlighted the importance of Deaf BSL therapists

(North West BSL Healthy Minds Evaluation Report, 2014)

PWP Training Evaluation

• Evaluate effectiveness of BSL delivered/assessed training

• Based on 2 PWP cohorts (2012, 2014)

• BSL IAPT course review with LJMU course provider

• Compare with student experience of accessing previous mainstream courses

PWP Training Evaluation

Comparison of Deaf and mainstream course delivery

Hearing Deaf

• 30 students

• Generalised information

• Referenced but not discussed

• Students to undertake research on

own initiative

• Discussions based on theory and

experience

• Few questions asked

• Lecture style classroom setting

• Academic/jargon language

• 8 students

• Deaf focused/related

• References discussed in detail

• Pointers on where/how to use

references

• In depth discussion and role plays

• Examples required for clarity and

understanding

• Many questions asked

• Semi circle classroom setting to

enable visual display for discussion

• Less academic/jargon language

Evaluation Conclusion

The future for BSL IAPT training for Deaf students to have access to a BSL course

• Learning styles

• Removes need for double processing

• Open communication

• Less tutors

32 recommendations for training providers

• Pre-course academic preparation

• Increase pool of observers

• Creating guidelines for Language Support Workers

• Deadlines

• Recruitment selection process

Hard to reach…

Why are BSL users

different?

What is a hard to reach group?

• Culturally & linguistically diverse communities

• Young people

• Elderly people

• Disabled people

• Domestic violence - Sexual/Physical/Emotional abuse

• Homeless

• Substance misuse

• LGBT

• Faith based communities

• Military veterans

Hidden from the population – makes sampling difficult (Brackertz, 2007)

Why are Deaf people hard to reach?

• Dispersed community

• Specific Deaf Culture

• Communication

• Language

• Access

• Lack of Deaf/BSL awareness

• Lack of engagement – stigma/fear

• English as a second language or limited understanding

This results in ……..

• Poor access to information

• Poor access to services in particular mental health provision

• Mainstream services unable to engage the Deaf community

• Higher than average physical health problems

• Higher than average mental health problems

Consequences of not accessing Deaf Service early on

Case Study – Laura

Background:

– Physically abused by father, gang raped (15 yrs.)

– DV ex-husband and ex-boyfriend

– Difficult relationship with mother

Therapies:

– 3 episodes of treatment attempted before referred to BSLHM

– 2 sessions with hearing counsellor in refuge

– Therapy following crisis – self harming so severe had hospital

admission

– 10 sessions in a mainstream IAPT service

– Assessment with BSLHM – treatment offered

IAPT for BSL users – Best Practice

• Good understanding of the needs of Deaf BSL users

• Knowledge of other deaf services for sign posting

• Recognition of the importance of past schooling,

family life, social network and barriers that deaf

people experience

• Treatments to be linguistic and cultural appropriate

• The therapist to have the skill to work with Deaf

norms that will impact on the success of treatment

IAPT for BSL users – Best Practice

• Ability to undertake risk assessments in BSL and take

appropriate action

• Ability to engage with the Deaf patient and have

suitable worksheets for homework tasks

• Knowledge of how/where to access BSL information

regarding specific issues ie; bereavement, low self

esteem and others

• Clear communication - BSL, appropriate non verbal

communication ie; eye contact, culturally appropriate

Commissioning issues

Experience of trying to work with commissioners to secure a BSL Psychological Therapy Service

• Lack of understanding of mental health & deafness

• Finance – IFR/Contract/SLAs on an individual basis

• CCGs unable/unwilling to work with colleagues from neighbouring CCGs to ensure reduced cost

Commissioning issues

• Clinical excellence – appears to not be seen as a priority

• Mainstream service provision promoted in some areas – more costly and a negative experience for the patient.

• 35% of patients seen through BSL Healthy Minds have tried and failed to access mainstream IAPT services

• Choice – Deaf people have ‘no choice’ of how they receive therapy

• Care pathway – complex and inaccessible for the majority of the Deaf population

Forward thinking for Cost Effectiveness and Best Practice

• Contract/SLA secured – saves time, less angst for the patient

• Innovative and creative collaborative commissioning at local level

• National funding

• Real choice for BSL users – a choice of BSL fluent therapist

• Seamless care pathway

• Working with mainstream therapy services

National Developments

• Guided Self-help materials in BSL to be updated

• National Guidance Document through the Joint Commissioning Panel with RCP

• BSL psycho-education groups

• Visual online therapy - BSL

• Mental Health & Deafness Masterclass events for commissioners and providers

• Training: Counselling for Depression (CfD)

High Intense Therapy (HIT)

PWP IAPT Cohort 3 onwards

Short courses

For further information please contact:-

Hazel Flynn

Clinical Management Lead

Kay Helliwell

Data Performance & Contracts Lead

Tel: 01494 687 606

SMS: 07807 672 838

Email: hflynn@signhealth.org.uk

khelliwell@signhealth.org.uk

References

BSL Healthy Minds

BSL Healthy Minds is a therapy and counselling service delivered in British Sign Language.

http://www.signhealth.org.uk/our-projects/bsl-healthy-minds/

Sick of It Report

This is a report on a 5 year study by SignHealth on the health of Deaf people. The report highlights issues that

Deaf people face when accessing health services and offers recommendations to improve access.

http://www.signhealth.org.uk/health-information/sick-of-it-report/sick-of-it-in-english/

BSL Healthy Minds Evaluation Report

This is an Evaluation Report based on services provided by BSL Healthy Minds from October 2011 - November

2013. The report compares BSL Healthy Minds IAPT figures alongside national IAPT figures.

http://www.nwppn.nhs.uk/images/news/NorthWestBSLIAPTEvaluationReportAV.pdf

BSL Healthy Minds BSL IAPT Training Report 2014

This report evaluates the BSL IAPT training course with feedback from Cohorts 1 & 2, Tutors, University Course

Leaders and BSL Healthy Minds management team. The report highlights successes along with areas for

improvement with recommendations offered.

http://www.nwppn.nhs.uk/attachments/article/97/BSLTrainingReport2014.pdf

References

Equality Act 2010

http://www.legislation.gov.uk/ukpga/2010/15/contents

Healthy Lives, Healthy People: Our strategy for public health in England (2010) White Paper

https://www.gov.uk/government/publications/healthy-lives-healthy-people-our-strategy-for-public-health-in-

england

Commissioning IAPT for the whole community (2008)

http://www.iapt.nhs.uk/silo/files/commissioning-iapt-for-the-whole-community.pdf

No Health without mental Health (2011)

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213761/dh_124058.pdf

Improving Access to Psychological Therapies (IAPT) Commissioning Toolkit (2008)

http://www.iapt.nhs.uk/silo/files/improving-access-to-psychological-therapies-iapt-commissioning-toolkit.pdf

Everyone Counts: Planning for Patients 2014/15 to 2018/19

http://www.england.nhs.uk/wp-content/uploads/2013/12/5yr-strat-plann-guid-wa.pdf

A Sign of the Times

http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/consultations/closedconsultations/dh_4016951

Mental Health & Deafness – Towards Equity & Access (2005)

http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh

_digitalassets/@dh/@en/documents/digitalasset/dh_4104005.pdf